Off-Label Use of Antipsychotics in Nursing Home Continues

The use of antipsychotic medications in United States nursing homes has not significantly decreased despite that the Centers for Medicare and Medicaid Services (CMS) had announced an initiative in May 2012 to reduce the use of the drugs by 15 percent at the end of last year.

The decline has been modest and, in some cases, some New York facilities have increased their use of antipsychotic drugs, according to The New York World. The Center’s initiative came after some journalistic investigation that covered the ubiquitous use of the drugs. Overall, the decline seen nationwide was under 8 percent and, in New York City, the rate only declined by 5.4 percent in 2012.

Last year, we wrote that CMS was hoping to curb the use of antipsychotic medications in nursing homes, a growing and dangerous issue on which we have long been writing. As we’d said, there are dangers in the needless dosing of the elderly with antidepressants, antipsychotics, and sedatives, which are sometimes given for seemingly pointless reasons and appear to be linked to falls, other accidents in the elderly, and death.

The issue is that antipsychotics are being used off-label in nursing homes to treat a host of unapproved diagnoses, including dementia. There are no drugs currently approved by the U.S. Food & Drug Administration (FDA) to manage agitation, aggression, and hallucinations in the elderly and those diagnosed with Alzheimer’s disease and dementia. Risks associated with the use of antipsychotic medications include diabetes, movement disorders that can become permanent, pneumonia, stroke, weight gain, and sudden cardiac death.

According to the CMS in 2012, the rising practice of unnecessarily treating the elderly with antipsychotics represents a significant change in how dementia care was traditionally handled. The FDA stated that antipsychotics can lead to dizziness, sudden blood pressure drops, abnormal heart rhythm, blurred vision, and urinary problems in dementia patients. Yet, prior reports found that more than one in five U.S. nursing homes administered antipsychotics to people with no diagnosis for a condition warranting use of the drugs. In fact, in 2010, some 185,000 U.S. nursing home residents received antipsychotics even though prescribing these drugs went against federal nursing home regulator recommendations. Many were suffering from Alzheimer’s disease or some other dementia-related disorder despite that antipsychotics are intended for people diagnosed with schizophrenia.

The 15 percent reduction is discouraging, say patient advocates who felt the goal was insufficient to begin with, according to The New York World. “We were concerned because we didn’t think that 15 percent was enough of a reduction. So not even being able to reach that mark is of great concern to us,” Robyn Grant, director of public policy and advocacy for The National Consumer Voice for Quality Long-Term Care, told The New York World. “The 15 percent was something that the nursing home industry put out there and proposed. My guess would be they were putting it at a rate that they thought they could accomplish, which just underscores how disappointing it is and how troubling it is that they didn’t achieve their own goal,” Grant added.